Behavioral Science
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188 Deja Review: <strong>Behavioral</strong> <strong>Science</strong><br />
In what other circumstances<br />
can a physician breach patient<br />
confidentiality?<br />
When can a patient be “committed”<br />
or involuntarily hospitalized?<br />
If a patient is involuntarily hospitalized,<br />
can a physician administer any<br />
treatment they want?<br />
How do mentally ill patients receive<br />
treatment even if they refuse treatment?<br />
If the patient signs a written authorization,<br />
the physician may disclose private<br />
health information consistent with the<br />
authorization. State law may also<br />
authorize a physician to share private<br />
health information with specified people<br />
who are at risk for contracting HIV from<br />
a patient. Disclosure of this information<br />
is controlled by state law, and physicians<br />
must proceed carefully because if state<br />
law does not authorize disclosing<br />
HIV/AIDS information, the physician<br />
may be guilty of violating Health<br />
Insurance Portability and Accountability<br />
Act of 1996 (HIPAA) which may result<br />
in fines and a prison sentence.<br />
The process varies by state, but a patient<br />
who presents a substantial risk of<br />
imminent harm to himself or herself or<br />
others, or if a patient is so unable to care<br />
for his or her own physical safety as to<br />
create an imminently life-endangering<br />
crisis, then the patient needs involuntary<br />
inpatient treatment.<br />
No. Even an involuntarily committed<br />
patient has the right to refuse medical<br />
treatment.<br />
A judge can order the administration<br />
of treatment if the patient is found<br />
incompetent to refuse treatment. Also,<br />
if the patient is violent and posing an<br />
immediate, severe danger to himself or<br />
herself or others, this is considered a<br />
medical emergency and the physician<br />
may administer treatment without the<br />
patient’s consent.<br />
CLINICAL VIGNETTES<br />
Your patient has metastatic lung cancer and he is nearing the last weeks of his life.<br />
He is in considerable pain and is having trouble breathing without being<br />
intubated. His wishes were to not be intubated or having any life-prolonging<br />
measures. His son asks if you can do anything for his pain. You ask the nurse<br />
about giving him more morphine and she says that the respiratory depression will<br />
kill him. Is it ethical to do this?<br />
Yes—it is ethically permissible under the principle of double-effect even if it<br />
causes his death, as long as your primary goal is to treat his pain.
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